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UNI' STATES BANKRUPTCY COURT, DIST' T OF ARIZONA In re: Case Nos. 90-05052-PHX-GBN to 90-0547� JX- THE X; Il{ p„ THE CIRCLE K CORPORATION, ET AL., (Jointly Administered) DEBTORS. PROOF OF CLAIM SEP 18 1070 "'IRONMENTAL HEALTH SEE INSTRUCTIONS AT BOTTOM OF REVERSE SIDE CREDITOR: 918884 This claim is asserted against: COUNTY OF SAN JOAQUIN PUBLIC HEALTH SERVICE l ) The Circle K Corporation 90-05052-PHX-GBN 1601 E HAZELTON AVE 1 ) CIRCLE K CONVENIENCE STORES, INC. 90-05053-PHX-GBN STOCKTON, CA 95201 l ) Circle K Management Company 90-05054-PHX-GBN ( ) LAR-LIN, INC. 90-05055-PHX-GBN ( ] FIRST CIRCLE PROPERTIES, INC. 90-05056-PHX-GBN If no label in box above or if label ( ] UtoteM, Inc. 90-05057-PHX-GBN information is incorrect, please complete: ( ) UtoteM MARKETS OF ARIZONA, INC. 90-05058-PHX-GBN l ) U Totem of Alabama, Inc. 90-05059-PHX-GBN ( ) U-TOTE'M OF COLORADO INC. 90-05060-PHX-GBN Name of Creditor f ) U-TOTEM OF MIAMI, INC. 90-05061-PHX-GBN ( ) TIC TOC SYSTEMS, INC. 90-05062-PHX-GBN f ) MONTERRE PROPERTIES, INC. 90-05063-PHX-GBN Street Address ( ) SHOP 6 GO, INC. 90-05064-PHX-GBN ( ) CIRCLE K GENERAL, INC. 90-05065-PHX-GBN ( ) CIRCLE K HAWAII, INC. 90-05066-PHX-GBN City/State/Zip Code ( ) COMBINED AVIATION CO. 90-05067-PHX-GBN ( ) Charter Marketing Company 90-05068-PHX-GBN Amount of claim: 5 ( ) Charter Marketing Company (Connecticut) 90-05069-PHX-GBN ( ) MR. B'S OIL CO., INC. 90-05070-PHX-GBN Type of Claim: ( ) General Unsecured l ) MR. B'S FOOD MART, INC. 90-05071-PHX-GBN ( ) Secured (See paragraph 8) ( ) NPI Corporation 90-05072-PHX-GBN ( ) Priority (See paragraph 9) ( ) OLD COLONY PETROLEUM 90-05073-PHX-GBN COMPANY, INC. Basis for claim: ( ) Goods purchased ( ) New England Petroleum Distributors, Inc. 90-05074-PHX-GBN ( ) Services performed ( ) 44th Street & Camelback Limited Partnership 90-05075-PHX-GBN ( ) Monies loaned ( ) Contractual obligation ( ) Personal injury/Wrongful This proof of claim: death/Property damage ( ) Employment matter ( ) is the first filed proof of claim evidencing the asserted claim ( ) Other: ( ) amends/supplements a proof of claim filed on 1 ) replaces/supersedes a proof of claim filed on 1. The debtor was, at the time of the filing of the petition initiating this case (May 15, 1990), and still is, indebted or liable to this claimant in the sum of $ 2. The consideration for this debt or the ground of liability is as follows: 3. If the claim is founded upon a writing, the writing on which this claim is founded (or a duplicate thereof) is ( ) attached hereto, or 1 ) cannot be attached hereto for the following reason: (SEE REVERSE SIDE) CLAIM NO.